Acute mastoiditis in children: where do we stand?

Background: Acute mastoiditis in children remains an otological challenge, assuming itself as the most frequent complication of acute otitis\nmedia. Although the use of antibiotic therapy has reduced the need for\nsurgical intervention, the latter is frequently used in the treatment of\nacute mastoiditis and its complications. The objective of this study is to\nanalyze the approach to acute mastoiditis nowadays using our experience in the Otorhinolaryngology department of Hospital Dona Estefânia,\nLisbon, Portugal.\nMaterial and Methods: We retrospectively studied the clinical charts of\nall children (n=226) with the diagnosis of acute mastoiditis admitted to\nour department during the period of 2000 to 2014 (15 years). Data regarding symptomatology, relevant findings of complementary exams,\npresence of complications and mainly therapeutic approach and their\nimplications were studied.\nResults: During the study period, 167 clinical records fulfilled criteria\nfor inclusion. Boys (n=92) were much more frequently affected than\ngirls. Their ages ranged from 1 month to 17 years (mean age 3 years and\n7 months). History of previous acute otitis media episodes was registered in 41,3% (n=69) of patients. In our series, associated complications (all present on admission) occurred in 27% of cases (n=45). All patients were submitted to empiric\nintravenous antibiotics. Surgical management included myringotomy (n=20) and myringotomy with\ntranstympanic ventilation tubes (n=18) on admission upon the group without complications. A more\nagressive approach was undertaken in 45 children with associated complications. The mean length of hospital stay was 8.5 days. All patients recovered uneventfully. It was registered one recurrence of mastoiditis\nbut the child was asymptomatic during the events.\nConclusion: Acute pediatric mastoiditis remains a potentially problematic infection even in the antibiotic\nera. According to recent literature, the incidence of this complication is increasing, which was not observed in our study. This entity should be the subject of clinical attention so that an appropriate therapeutic\napproach can be provided.